Active NPI
Kevin Scott Naceanceno, MD
- Surgery Physician
- Saint Louis, MO
National Provider Identifier
1356026199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 2023022758
- Practice address
- 1 Barnes Jew Hosp PLZ
Saint Louis, MO 63110-1003 - Phone
- (314) 362-1935
- NPI assigned
- Jun 20, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 2023022758 | MO | Primary |
Addresses
Primary practice location
1 Barnes Jew Hosp PLZ
Saint Louis, MO 63110-1003
Mailing address
660 South Euclid Avenue
Campus Box 8109
St. Louis, MO 63110-1093
Phone (314) 362-8028
Other practice location 1
915 N Grand Blvd
Saint Louis, MO 63106-1621
Phone (314) 362-1935
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230718002670 | MO | Order and Referring Only - Thoracic Surgery | 3375903644 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington University Physicians in Illinois, Inc | Past | Accepting new patients |
Interoperability endpoints
- knaceanceno1050585@direct.carenet.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Saint Louis, MO
- NPI 1457203135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687219200000",
"number": "1356026199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 SOUTH EUCLID AVENUE",
"address_2": "CAMPUS BOX 8109",
"city": "ST. LOUIS",
"state": "MO",
"postal_code": "631101093",
"telephone_number": "314-362-8028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BARNES JEW HOSP PLZ",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101003",
"telephone_number": "314-362-1935"
}
],
"practiceLocations": [
{
"address_1": "915 N Grand Blvd",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631061621",
"country_code": "US",
"telephone_number": "314-362-1935",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NACEANCENO",
"first_name": "KEVIN",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-20",
"last_updated": "2023-06-20",
"certification_date": "2023-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MO",
"license": "2023022758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.